リウマチ性多発筋痛症に両眼性動脈炎型前部虚血性視神経症を合併した1例

Bilateral arteritic amterior optic neuropathy in a case of polymyalgia rheumatica

要約　目的：リウマチ性多発筋痛症に両眼性動脈炎型前部虚血性神経症が併発した症例の報告。症例：89歳女性が前日からの両眼視野障害で受診した。2か月前からリウマチ性多発筋痛症の症状があり，3日前に巨細胞性動脈炎の症状があった。所見：矯正視力は右0.5，左0.08で，両眼に乳頭浮腫と視野狭窄があった。血沈値の上昇があり，リウマチ性多発筋痛症に併発した巨細胞性動脈炎と動脈炎型の両眼性前部虚血性神経症と診断した。ステロイドパルス療法を開始し，2か月後に右眼の視機能は回復した。5か月後の現在まで，前部虚血性神経症の再発はない。結論：リウマチ性多発筋痛症に併発した巨細胞性動脈炎と動脈炎型の前部虚血性神経症の病変が，早期の診断と治療で軽快した。

Abstract.　Purpose：To report a case of polymyalgia rheumatica who developed bilateral arteritic anterior optic neuropathy. Case：An 89-year-old female presented with bilateral visual field defect since the previous day. She had had symptoms of polymyalgia rheumatica since 2 months before. She had had signs of giant cell arteritis since 3 days before. Findings：Corrected visual acuity was 0.5 right and 0.08 left. Both eyes showed papilledema and constricted visual field. She showed elevated sedimentation rate. She was diagnosed with polymyalgia rheumatic, giant cell arteritis, and bilateral arteritic anterior optic neuropathy. Corticosteroid pulse therapy was followed by normalization of visual function in the right eye 2 months later. There has been no recurrence for 5 months until present. Conclusion：The present case illustrates that early diagnosis and treatment are essential for polymyalgia rheumatic associated with giant cell arteritis and bilateral arteritic anterior optic neuropathy.